I have an Ultrasound questions topic going in the TTC boards, and some have asked me to put one here. I am a Registered Generalist Sonographer with American and Canadian Credentials, and have the OB/GYN specialties (among others). Feel free to ask anything

Hello, I do have a question or I guess just want to know if this sounds normal...I am 10 weeks, at 7 weeks I had an ultrasound and saw a healthy heartbeat. I went back at 10 and they did another and the baby was really low, almost at my pelvic bone. We could clearly see the baby, saw it move, and heard its heartbeat. My badder was really full and pushing down on the baby so she told me to empty my bladder in the hopes we could get a better image for some pictures. When I did, it looked like the baby disappeared. The images were terrible and totally fuzzy...I couldn't tell where the baby was anymore at all but she said because she looks at this all the time she could tell and pointed to the screen. I still couldn't see anything is this normal??? Thanks so much for reading!

Thank you so much for this thread! I have some questions that you might be able to answer.

I had fluctuating progesterone levels early on so I was put on suppositories, then had some spotting after that. I had extremely high hCG levels measured four times (see sig). At my first US at 7w3d (charting, sure of O date), they found one big gestational sac, two yolk sacs, and two fetal poles - twins! The bigger one on the left measured 10 days behind at 5w6d and had a tiny flicker of a heart that they couldn't get a rate for. The smaller one on the right was still and they didn't tell me its measured size.

Is it normal for identical twins to measure behind on an early scan? In your experience can these little guys catch up? I had my beta drawn again and, while it increased a little from two weeks prior, it is now lower than average for a singleton at that gestational age. Could this mean that one twin miscarried and the other one could be ok? Could this also be a normal plateau and everything is fine? I have a followup US this week so hopefully I'll get definitive answers soon, but I know I will not be able to focus on anything else between now and then!

erin860 wrote:Hello, I do have a question or I guess just want to know if this sounds normal...I am 10 weeks, at 7 weeks I had an ultrasound and saw a healthy heartbeat. I went back at 10 and they did another and the baby was really low, almost at my pelvic bone. We could clearly see the baby, saw it move, and heard its heartbeat. My badder was really full and pushing down on the baby so she told me to empty my bladder in the hopes we could get a better image for some pictures. When I did, it looked like the baby disappeared. The images were terrible and totally fuzzy...I couldn't tell where the baby was anymore at all but she said because she looks at this all the time she could tell and pointed to the screen. I still couldn't see anything is this normal??? Thanks so much for reading!

Hi Erin!

Don't worry - sometimes a really full bladder can artificially elongate the cervix and make the implantation site look lower than normal. I'm certain everything is fine. As long as youare not cramping or bleeding and there is a good heartrate above 120, you're doing great!Getting a good image of a fist trimester fetus can be challenging. It depends on fetal position (sometimes they plaster themselves against the wall of the gestation sac), sometimes overlying fat or gas can get in the way, and the shape and orientation of the uterus can take baby further from the probe face. This is why we like endovaginal scans for first trimester, we can get really close and the baby can be seen clearly I'll bet you at your 18-20 week sacn you will see everything perfectly!

chorse37 wrote:Thank you so much for this thread! I have some questions that you might be able to answer.

I had fluctuating progesterone levels early on so I was put on suppositories, then had some spotting after that. I had extremely high hCG levels measured four times (see sig). At my first US at 7w3d (charting, sure of O date), they found one big gestational sac, two yolk sacs, and two fetal poles - twins! The bigger one on the left measured 10 days behind at 5w6d and had a tiny flicker of a heart that they couldn't get a rate for. The smaller one on the right was still and they didn't tell me its measured size.

Is it normal for identical twins to measure behind on an early scan? In your experience can these little guys catch up? I had my beta drawn again and, while it increased a little from two weeks prior, it is now lower than average for a singleton at that gestational age. Could this mean that one twin miscarried and the other one could be ok? Could this also be a normal plateau and everything is fine? I have a followup US this week so hopefully I'll get definitive answers soon, but I know I will not be able to focus on anything else between now and then!

Hi there

great question, and I'm sorry for all your worry, I know it can be a stressful time waiting for answers. Last menstrual periods are no very accurate ways of dating pregnancies, even if you are sure of your dates. These are monochorionic diamniotic monozygotic twins (identical twins that share a placenta but have separate amniotic sacs). Because they divided to make two individuals a bit later than usual, they share a placenta. If they waited one day more, they would share an amniotic sac. One day more, and they would be conjoined.

Because of the extra step of duplication, it can make them measure a bit smaller, but the likely scenario is either a dating error because the embryos were soooo small, or because fertilization was delayed, or a combo of the two.At this early stage, the heart rate is slow and can be difficult to obtain an m-mode sample on an extremely small flutter, especially when mom is breathing and the babies are so small. I usually get the mom to hold her breath when I take heart rate samples.

Don't be concerned about movement, at this early gestational age, you wouldn't see movement anyway. We actually do not diagnose death on an embryo until the CRL measures close to 10 mm now. It's very possible that the smaller embryo has not started it's heart beating yet.

Don't worry about your HCG - the "normal range" can wary wildly at every week of gestation.

They look really good here actually. Please let me know how your follow up scan goes! I can't promise anything, but I'm trying to be positive and praying that both your twins make it!

I appreciate your insights! It was nice to hear that they were looking good at that time; it really gave me some hope. Thank you for addressing all of my questions, too. During my appointment I was too overwhelmed to think through everything.

My followup was only bad news, unfortunately. One twin had vanished, and the other, even though it was a bit bigger than last week, still had no measurable heartbeat. My doc told me to stop taking the progesterone and expect to miscarry naturally within a week or two.

chorse37 wrote:I appreciate your insights! It was nice to hear that they were looking good at that time; it really gave me some hope. Thank you for addressing all of my questions, too. During my appointment I was too overwhelmed to think through everything.

My followup was only bad news, unfortunately. One twin had vanished, and the other, even though it was a bit bigger than last week, still had no measurable heartbeat. My doc told me to stop taking the progesterone and expect to miscarry naturally within a week or two.

I am so so so sorry to hear your sad news :'( Such a difficult thing to deal with. I hope I didn't give false hope, I was really trying to be optimistic, I desperately wanted that joy for you I wish I was there to give you a hug. Take all the time you need to grieve your little angels, it's a process. You are a healthy woman and I pray you are blessed again very soon.Take good care of yourself, and treat yourself with kindess these next few weeks.

FrostedFuji wrote:I'm curious, how are you able to tell from the photo that they're mo/di twins? (Aside from "lots and lots of training & practice" )

chorse, I have my fingers crossed for you that you get good news at your followup

Hi There

I was able to tell because the single big black fluid sac is the gestation sac. One gestation sac often means one placenta (monochorionic) , but each baby can sometimes have their own. This is something that has to be decided early in the pregnancy, as the placentas can grow so close together they look like one big placenta. If there were two black sacs, that would be two gestation sacs and two placentas, or dichorionic.

Monoamniotic means both twins are in the same amniotic sac. Diamniotic means they are in two separate bags.

@CHorse, I read your update yesterday, but didn't initially respond because I hadn't been active at all on this post, and didn't want to impose. But I thought about you all day yesterday. I felt like I could almost feel what you were feeling and I wanted so badly to send you some peace and some comfort. I hope you and your DH are doing ok, and I hope your process from here goes as smoothly as possible. I'm so sorry for your losses.